Systems and methods for left atrial appendage closure

Abstract

Embodiments of the present invention encompass systems and methods for delivering ligatures to anatomical features of a patient. Exemplary ligature delivery systems for use in delivering a ligature to a left atrial appendage ligature include an elongate support mechanism having a proximal portion and a distal portion, a flexible hoop assembly, and a cinchable constriction member. The flexible hoop assembly can be coupled with the distal portion of the elongate support mechanism, and can include a support body coupled with a support frame. The support frame can be biased to hold the support body in a trailing configuration, whereby a free portion of the support body is disposed proximal to the distal portion of the elongate support mechanism. The support frame of the flexible hoop assembly can be coupled with the distal portion of the elongate support mechanism. The support body can be configured to support the cinchable constriction member and a loop of the left atrial appendage ligature.

What is claimed is: 
     
       1. A ligature delivery system for applying a left atrial appendage ligature on a left atrial appendage, the ligature delivery system comprising:
 an elongate support shaft having a proximal portion and a distal portion; 
 a handle portion located at the proximal portion of the elongate support shaft 
 a flexible hoop assembly coupled with the distal portion of the elongate support shaft, the flexible hoop assembly defining a hoop profile and an outer surface, where the flexible hoop assembly comprises a flap defining an open channel having an inner surface exposed and extending along the outer surface, where the flexible hoop assembly comprises a support body extending about the hoop profile coupled with a support frame extending about the hoop profile, the support body having a lumen, the lumen receiving the support frame within, the support frame is biased to hold the support body in a trailing configuration whereby a free portion of the support body is disposed proximal to the distal portion of the elongate support shaft; and 
 a constriction member coupled to the flexible hoop assembly, wherein the constriction member comprises an undeployed configuration and a deployed configuration, wherein in the undeployed configuration the constriction member is received within the open channel, wherein in the deployed configuration the constriction member is configured to be cinched to constrict in diameter about the left atrial appendage, wherein in the deployed configuration the constriction member is removed from the flexible hoop assembly and the inner surface of the open channel remains exposed; 
 wherein the support frame of the flexible hoop assembly is coupled with the distal portion of the elongate support shaft, and 
 wherein the support body is configured to support the constriction member and the left atrial appendage ligature. 
 
     
     
       2. The ligature delivery system according to  claim 1 , further comprising a constriction control member operatively linked to the constriction member such that actuation of the constriction control member cinches the constriction member about the left atrial appendage. 
     
     
       3. The ligature delivery system according to  claim 1 , further comprising a ligature control member located on the handle portion, the ligature control member configured to reduce a diameter of the left atrial appendage ligature to cinch the left atrial appendage ligature about the left atrial appendage. 
     
     
       4. The ligature delivery system according to  claim 1 , further comprising a deflector body that pivots relative to the elongate support shaft, wherein the support frame of the flexible hoop assembly is coupled with the distal portion of the elongate support shaft via the deflector body. 
     
     
       5. The ligature delivery system according to  claim 4 , further comprising a deflection control member located on the handle portion and linked to the deflector body, such that actuation of the deflection control member causes the deflector body to pivot relative to the elongate support shaft. 
     
     
       6. The ligature delivery system according to  claim 1 , further comprising a lumen that is adapted to receive a visualization device. 
     
     
       7. A method of delivering a ligature loop to a left atrial appendage of a patient, the method comprising:
 advancing an elongate support shaft of a ligature delivery system toward the left atrial appendage of the patient, wherein the ligature delivery system includes a flexible hoop assembly coupled with a distal portion of the elongate support shaft, where the flexible hoop assembly comprises a flap defining an open channel having an inner surface exposed and extending along an outer surface, the flexible hoop assembly disposed in a trailing configuration and being adjustable about an axis such that the flexible hoop assembly can pivot independently of the elongate support shaft; 
 cinching a constriction member so as to constrict the left atrial appendage, wherein the constriction member comprises an undeployed configuration and a deployed configuration, wherein in the undeployed configuration the constriction member is received within the open channel, where the flap is configured to fold in the deployed configuration, wherein in the deployed configuration the constriction member is removed from the flexible hoop assembly and the inner surface of the open channel remains exposed; and 
 delivering the ligature loop from the flexible hoop assembly to the constricted left atrial appendage while the constriction member constricts the left atrial appendage. 
 
     
     
       8. The method according to  claim 7 , wherein the step of cinching the constriction member about the left atrial appendage comprises actuating a constriction control member operatively linked to a control mechanism of the ligature delivery system. 
     
     
       9. The method according to  claim 7 , wherein the flexible hoop assembly comprises a support body coupled with a support frame, and wherein the support frame is biased to hold the flexible hoop assembly in the trailing configuration whereby a free portion of the support body is disposed proximal to the distal portion of the elongate support shaft. 
     
     
       10. The method according to  claim 7 , wherein the flexible hoop assembly is coupled with the distal portion of the elongate support shaft via a deflector body, and the method further comprises pivoting the deflector body of the ligature delivery system relative to the elongate support shaft. 
     
     
       11. The method according to  claim 10 , wherein the ligature delivery system comprises a deflection control member located at a proximal end of the elongate support shaft and operatively linked with the deflector body, and the method further comprises actuating the deflection control member to cause the deflector body to pivot relative to the elongate support shaft. 
     
     
       12. The method according to  claim 7 , wherein the ligature delivery system comprises a lumen that receives a visualization device, the method further comprising visualizing the left atrial appendage with the visualization device. 
     
     
       13. The method according to  claim 7 , wherein the ligature delivery system comprises a suction mechanism, the method further comprising transmitting suction from a suction source to the left atrial appendage of the patient. 
     
     
       14. The method according to  claim 13 , wherein the suction mechanism comprises a suction pod, the method further comprising drawing tissue of the left atrial appendage of the patient into the suction pod. 
     
     
       15. A ligature delivery system for use with a left atrial appendage ligature, the ligature delivery system comprising:
 an elongate support shaft; 
 a flexible hoop assembly coupled with the elongate support shaft, the flexible hoop assembly biased in a trailing configuration whereby a free portion of the flexible hoop assembly is disposed proximal to a distal portion of the elongate support shaft, where the flexible hoop assembly comprises a flap defining an open channel having an inner surface exposed and extending along an outer surface, where the flexible hoop assembly is coupled to the elongate support shaft through a linkage body, where the flexible hoop assembly is configured to pivot relative to the linkage body to pivot independently from the elongate shaft; and 
 a constriction member configured to constrict the left atrial appendage, wherein the constriction member comprises an undeployed configuration and a deployed configuration, wherein in the undeployed configuration the constriction member is received within the open channel, where the flap is configured to fold in the deployed configuration, wherein in the deployed configuration the constriction member is removed from the flexible hoop assembly and the inner surface of the open channel remains exposed; and 
 wherein the flexible hoop assembly is configured to support the constriction member and a loop of the left atrial appendage ligature. 
 
     
     
       16. The ligature delivery system according to  claim 15 , wherein the flexible hoop assembly comprises a groove configured to receive the constriction member. 
     
     
       17. The ligature delivery system according to  claim 16 , wherein a portion of the groove is defined by a flap that collapses flexibly in response to a cinching force applied by the constriction member. 
     
     
       18. The ligature delivery system according to  claim 15 , wherein the flexible hoop assembly comprises a channel configured to receive the loop of the left atrial appendage ligature. 
     
     
       19. The ligature delivery system according to  claim 18 , wherein a portion of the channel is defined by a flap that collapses flexibly in response to a cinching force applied by the loop of the left atrial appendage ligature. 
     
     
       20. The ligature delivery system according to  claim 15 , further comprising a suction mechanism configured to transmit suction from a suction source to a left atrial appendage of a patient.